ASGE guideline on the role of endoscopy in the management of malignant hilar obstruction.

Published on Aug 1, 2021in Gastrointestinal Endoscopy9.427
· DOI :10.1016/J.GIE.2020.12.035
Bashar J. Qumseya22
Estimated H-index: 22
(UF: University of Florida),
Laith H. Jamil3
Estimated H-index: 3
(Oakland University)
+ 18 AuthorsSachin Wani71
Estimated H-index: 71
(Anschutz Medical Campus)
This clinical guideline from the American Society for Gastrointestinal Endoscopy (ASGE) provides an evidence-based approach for the management of patients with malignant hilar obstruction (MHO). This document was developed using the Grading of Recommendations Assessment, Development and Evaluation framework and addresses primary drainage modality (percutaneous transhepatic biliary drainage [PTBD] vs endoscopic biliary drainage [EBD]), drainage strategy (unilateral vs bilateral), and stent selection (plastic stent [PS] vs self-expandable metal stent [SEMS]). Regarding drainage modality, in patients with MHO undergoing drainage before potential resection or transplantation, the panel suggests against routine use of PTBD as first-line therapy compared with EBD. In patients with unresectable MHO undergoing palliative drainage, the panel suggests PTBD or EBD. The final decision should be based on patient preferences, disease characteristics, and local expertise. Regarding drainage strategy, in patients with unresectable MHO undergoing palliative stent placement, the panel suggests placement of bilateral stents compared with a unilateral stent in the absence of liver atrophy. Finally, regarding type of stent, in patients with unresectable MHO undergoing palliative stent placement, the panel suggests placing SEMSs or PSs. However, in patients who have a short life expectancy and who place high value on avoiding repeated interventions, the panel suggests using SEMSs compared with PSs. If optimal drainage strategy has not been established, the panel suggests placing PSs. This document clearly outlines the process, analyses, and decision processes used to reach the final recommendations and represents the official ASGE recommendations on the above topics.
#1Andrea Tringali (UCSC: Catholic University of the Sacred Heart)H-Index: 42
#2Ivo Boškoski (UCSC: Catholic University of the Sacred Heart)H-Index: 20
Last. Guido Costamagna (UCSC: Catholic University of the Sacred Heart)H-Index: 84
view all 3 authors...
Hilar cholangiocarcinoma (HCCA) involves a complex anatomical region where bile ducts, arteries, and veins create a complex network. HCCA can lead to biliary strictures at the main hepatic confluence, involving the right and left radicles. Endoscopic drainage of jaundiced patients with HCCA is challenging and carries a high risk of infective complications. HCCA needs a careful multidisciplinary evaluation to assess the indication and purposes (preoperative/palliative) of the biliary drainage. Bi...
#1Jin Ho Choi (New Generation University College)H-Index: 6
#2Sang Hyub Lee (SNU: Seoul National University)H-Index: 51
Last. Yong-Tae Kim (SNU: Seoul National University)H-Index: 27
view all 10 authors...
The ideal type of stent utilized at index endoscopic retrograde cholangiopancreatography (ERCP) in management of malignant hilar obstruction (MHO) remains unclear. We aimed to determine the ideal stent choice in patients with MHO. In this retrospective study, patients with unresectable MHO were separated into the plastic stent (PS) group and the self-expandable metal stent (SEMS) group. The primary outcome was the risk and rate of rescue percutaneous transhepatic biliary drainage (PTBD). The sec...
#1Lei Wang (Fujian Medical University)H-Index: 17
#2Nanping Lin (Fujian Medical University)H-Index: 5
Last. Jingfeng LiuH-Index: 27
view all 6 authors...
Background and aim Endoscopic biliary drainage (EBD) and percutaneous biliary drainage (PTBD) are the two main strategies of preoperative biliary drainage (PBD) for resectable malignant biliary obstruction (MBO) worldwide, but which is better remains unclear. Seeding metastasis (SM) has been reported repeatedly in the recent decade, although it is rarely taken into consideration in the choice of PBD. Hence, a systematic review was badly warranted to evaluate the incidence of SM between PTBD and ...
#1Alison L. Van Dyke (NIH: National Institutes of Health)H-Index: 14
#2Meredith S. Shiels (NIH: National Institutes of Health)H-Index: 48
Last. Jill Koshiol (NIH: National Institutes of Health)H-Index: 32
view all 7 authors...
BACKGROUND: Biliary tract cancers (BTCs) are rare but deadly cancers (gallbladder cancer [GBC], intrahepatic cholangiocarcinoma [ICC], extrahepatic cholangiocarcinoma [ECC], and ampulla of Vater cancer [AVC]). A recent US study reported increasing GBC incidence among people younger than 45 years and blacks; however, it did not examine trends for other biliary tract sites. METHODS: This study characterized demographic differences in BTC incidence rates and time trends by anatomic site. Population...
#1Robert J.S. Coelen (UvA: University of Amsterdam)H-Index: 17
#2Eva Roos (UvA: University of Amsterdam)H-Index: 8
Last. Thomas M. van Gulik (UvA: University of Amsterdam)H-Index: 77
view all 28 authors...
Summary Background In patients with resectable perihilar cholangiocarcinoma, biliary drainage is recommended to treat obstructive jaundice and optimise the clinical condition before liver resection. Little evidence exists on the preferred initial method of biliary drainage. We therefore investigated the incidence of severe drainage-related complications of endoscopic biliary drainage or percutaneous transhepatic biliary drainage in patients with potentially resectable perihilar cholangiocarcinom...
#1Jun-Guo Liu (Tianjin Medical University)H-Index: 2
#2Jing Wu (Tianjin Medical University)H-Index: 1
Last. Zhi Du (Tianjin Medical University)H-Index: 8
view all 8 authors...
Abstract Background: Hilar cholangiocarcinoma (HCCA) is a rare tumor, usually associated with obstructive jaundice and unfavorable prognosis. Obstructive jaundice can affect the liver, kidney, heart, and the immune system of the patients. Currently, controversy exists in whether preoperative biliary drainage (PBD) is of any benefit to the patients, and the best way for PBD in patients with resectable HCCA of malignant biliary obstruction remains to be determined. Objectives: To compare the clini...
#1Akito IwasakiH-Index: 6
#2Takamitsu SatoH-Index: 11
Last. Kensuke KubotaH-Index: 33
view all 5 authors...
#2Sachin WaniH-Index: 71
#3Bashar J. QumseyaH-Index: 22
Last. Aasma ShaukatH-Index: 46
view all 12 authors...
#1Firas H. Al-Kawas (Memorial Hospital of South Bend)H-Index: 27
#2Harry R. Aslanian (Yale University)H-Index: 29
Last. Patrick Yachimski (Vandy: Vanderbilt University)H-Index: 22
view all 39 authors...
Background The optimal approach to the drainage of malignant obstruction at the liver hilum remains uncertain. We aim to compare percutaneous transhepatic biliary drainage (PTBD) to endoscopic retrograde cholangiography (ERC) as the first intervention in patients with cholestasis due to suspected malignant hilar obstruction (MHO).
Cited By1
#1Mohammad Bilal (UMN: University of Minnesota)H-Index: 16
#2Martin L. Freeman (UMN: University of Minnesota)H-Index: 64
Abstract null Despite advances in gastrointestinal endoscopic technology, the management of malignant hilar biliary obstruction continues to be a challenge for advanced endoscopists. There has been ongoing debate regarding the optimal modality for both diagnostic and therapeutic interventions in malignant hilar obstruction. Various approaches including endoscopy, interventional radiology guided interventions and surgery are available. The management of malignant hilar biliary obstruction should ...
#1이태훈 ( Tae Hoon Lee ) (SCH: Soonchunhyang University)
#2문종호 ( Jong Ho Moon ) (SCH: Soonchunhyang University)
Last. 박상흠 ( Sang-heum Park ) (SCH: Soonchunhyang University)
view all 3 authors...
Malignant hilar obstruction (MHO) is considered an aggressive perihilar obstruction caused by cholangiocarcinoma, gallbladder cancer, or metastatic malignancies and has a poor prognosis. Although surgical resection is the only curative treatment method, the majority of patients with MHO do not undergo surgery due to an advanced inoperable state at presentation. Currently, effective biliary drainage provides the necessary palliation for symptomatic improvement. Among the drainage methods, percuta...
This website uses cookies.
We use cookies to improve your online experience. By continuing to use our website we assume you agree to the placement of these cookies.
To learn more, you can find in our Privacy Policy.